Adjustable guidewire

ABSTRACT

Guidewires useful for cooperating with catheters may be actively steered and/or provide adjustable stiffness. Angle or curvature of a guidewire, and/or flexural modulus of a guidewire, may be adjusted at one or more locations between ends thereof. Variable stiffness segments may include electrically operated compressible and/or extensible materials. Multiple tensile elements may terminate at different body elements to adjust angle or curvature at multiple locations. Multiple circumferentially and/or radially contractible fiber regions may be provided and distributed over a length of a guidewire. Adjustable flexure elements arranged in or along a guidewire may be electrically operated. A flexible core member may be centrally arranged in a tubular body. A flexible guide wire or track may cooperate with electrically operable motor units.

STATEMENT OF RELATED APPLICATION(S)

This application is a divisional of U.S. patent application Ser. No.16/078,388 filed on Aug. 21, 2018, which is a 35 U.S.C. § 371 nationalphase filing of International Application No. PCT/US2017/018638 filed onFeb. 21, 2017, which claims the benefit of U.S. Provisional PatentApplication No. 62/298,096 filed on Feb. 22, 2016, wherein thedisclosures of the foregoing applications are hereby incorporated byreference herein in their respective entireties.

TECHNICAL FIELD

This disclosure relates to guidewires being insertable into internalsites of mammalian bodies, and being useful for inserting, positioning,and moving catheters for diagnostic procedures, therapeutic procedures,and/or delivering therapeutic agents.

BACKGROUND

Catheters are used for performing diagnostic procedures and fordelivering therapeutic agents to internal sites within a human body thatcan be accessed through various lumen systems, such as the vasculature.A guidewire is a device used to enter tight spaces (e.g., obstructed ortortuous passages) within the body, or to assist in inserting,positioning, and moving a catheter—such as through bends and branches ofblood vessels. Guidewires vary in size, length, stiffness, composition,and tip shape. A conventional guidewire may include a slight bend at itsdistal end, and may be guided by selective rotation and advancementalong a pathway to a desired target location. Thereafter, the guidewiremay be held in place, and a catheter may be advanced along alongitudinal axis of the guidewire.

Insertion of a guidewire into a vessel lumen is schematicallyillustrated in FIG. 1A. A guidewire 10 is advanced into a target vessellumen 12, which may include multiple bends or turns 14, 16. As shown inFIG. 1B, the guidewire 10 is deflected as it is pushed forward againstwalls of the vessel lumen 12. Thereafter, as shown in FIG. 1C, acatheter 18 is advanced over the guidewire 10, which provides a stablesupport during advancement.

A side cross-sectional schematic view of a portion of a conventionalflexible guidewire 20 is shown in FIG. 2. A distal portion of theguidewire 20 includes a tip 22 (which may be convex along its outerperimeter) to which a longitudinal core wire or mandrel 24 and a safetyribbon wire embodied in a flexible coil 26 (e.g., distal coil) areattached. The core wire or mandrel 24 may include a constant diameterportion 24A over much of its length, as well as first and second reduceddiameter portions 24B, 24C between the constant diameter portion 24A andthe tip 22. As shown in FIG. 2, an external coating 28 may be providedover the constant diameter portion 24A of the longitudinal core wire ormandrel 24, and the flexible coil 26 may be provided over the first andsecond reduced diameter portion(s) 24B, 24C between the coated constantdiameter portion 24A and the tip 22. The flexible coil 26 may begenerally helical in shape, similar to a spring. A proximal coil portion26A including a first (e.g., smaller) coil pitch may extend over thefirst reduced diameter portion 24B of the core wire or mandrel 24, and adistal coil portion 26B including a second (e.g., larger) coil pitch mayextend over the second reduced diameter portion 24C of the core wire ormandrel 24, wherein the second reduced diameter portion 24C of the corewire or mandrel 24 has a smaller diameter than the first reduceddiameter portion 24B. Relative to the coated constant diameter portion24A, increased flexibility is provided by the first reduced diameterportion 24B of the core wire or mandrel 24 covered by the proximal coilportion 26A, and still further increased flexibility is provided by thesecond reduced diameter portion 24C of the core wire or mandrel 24covered by the distal coil portion 26B. The guidewire 20 is thereforetapered along its length, with decreasing diameter sections toward thetip 22 to reduce stiffness to allow for better steerability. Thus, theguidewire 20 has flexibility that increases with proximity to the tip22, and stiffness that increases with increasing distance away from thetip 22. As further shown in FIG. 2, the outside diameter of each of theexternal coating 28, the proximal coil portion 26A, and the distal coilportion 26B may be substantially the same. The external coating 28provides lubricity for navigation and for delivering catheters, and mayinclude materials such as PTFE, polyurethanes, or silicone-basedmaterials, that are preferably hydrophilic in nature. A coating mayfurther include Heparin or other therapeutic agents to reducethrombogenicity.

Maneuvering a guidewire within the body can be difficult. At least acertain degree of flexibility is necessary or desirable for mostapplications, but a guidewire must also maintain sufficient stiffness toprovide support to permit advancement of a catheter. A static guidewire20 such as illustrated in FIG. 2 may have regions with differingflexibility and stiffness properties proximate to the tip 22, but suchproperties are established during manufacture (therefore fixed withrespect to time) and are not subject to temporal alteration (e.g., withrespect to degree and/or position). Since stiffness of a staticguidewire cannot be changed, a guidewire must be exchanged with anotherwire if a different stiffness is needed, thereby prolonging a surgicalprocedure with concomitant risk to the patient. Examples of conventionalstatic guidewires (which come in various lengths, stiffnesses, andconfigurations) include LUNDERQUIST® Extra Stiff (Cook Inc.,Bloomington, Ind., US), Amplatz™, and ASAHI INTECC® Standard (Asahilntecc Co., Ltd., Nagoya, JP), among others.

Moveable core guidewires have been developed, such as the NAMIC®Angiographic Core Guidewire (North American Instrument Corp., HudsonFalls, N.Y., US) and the STARTER™ moveable core guidewire (BostonScientific Scimed, Inc., Maple Grove, Minn., US). In certain instances,moveable core guidewires can change stiffness by moving a core wirewithin an outer coil. With the core removed, the remaining outer coilprovides a flexible and generally atraumatic tip. A moveable core allowsfor changing a curvature of a J-shaped tip to aid in branch selection.However, frictional forces may render it difficult to move a corethrough an outer coil when the guidewire is positioned in a tightlycurved path, and movement of a core relative to an outer coil alsoentails the risk that a core may inadvertently stab through a coil,thereby risking puncture of adjacent tissue. Safe core movement istypically limited to the most distal 10 cm (proximate to a tip) of amoveable core guidewire. Generally, moveable core guidewires have outerdiameters of at least about 0.035 inch (0.89 mm) and tend to straightenwhen stiffness is increased.

Conventional guidewires may range in outer diameter from about 0.014inch (0.36 mm) to about 0.038 inch (0.97 mm) (with smaller valuescorresponding to static guidewires), and may vary in length from about45 cm to about 260 cm or more. Depending on the core material, aconventional static guidewire may have a minimum radius of curvature offrom about 18 mm to about 40 mm, and a movable core guidewire may have aminimum radius of curvature (without deformation of the metal core) offrom about 2 mm (e.g., in a state with the core removed) to about 18 mm(e.g., in a state with the core in place).

Guidewires that permit a certain degree of steerability have beendeveloped, such as disclosed in International Patent ApplicationPublication No. WO 2014/089273 A1 to Lenker et al. Additionally,guidewires with adjustable flexibility or stiffness are known, such asdisclosed in U.S. Pat. No. 7,018,346 B2 to Griffin et al. and U.S. Pat.No. 8,551,019 B1 to Kroll.

Despite various developments in the guidewire art, the art continues toseek advancements in guidewires that may be actively steered and/orprovide adjustable flexibility, to facilitate precise and rapidplacement of a catheter in a desired location within a body.

SUMMARY

The present disclosure relates to guidewires that may be activelysteered and/or provide adjustable stiffness. Active steering may includeadjustment of an angle and/or curvature of a guidewire at one or morelocations between a first end and a second end thereof. Adjustablestiffness may include adjustment of flexural modulus at one or morelocations between a first end and a second end thereof. A guidewire withcontrollable stiffness may fulfill the roles of both floppy and stiffguidewires during a procedure, thereby obviating the need for guidewireexchange.

In one aspect, a guidewire device includes a tube having a longitudinalaxis and an interior; and at least one variable stiffness segmentarranged within the interior of the tube, wherein the at least onevariable stiffness segment includes an electromagnet, at least onemagnetically responsive element, and a compressible and/or extensiblematerial arranged between the electromagnet and the at least onemagnetically responsive element. In the at least one variable stiffnesssegment, the electromagnet is configured to receive at least oneelectrical signal to selectively generate a magnetic field sufficient tointeract with the at least one magnetically responsive element, therebyexerting a compression or extension force on the compressible and/orextensible material to adjust a stiffness of the at least one variablestiffness segment.

In certain embodiments, the at least one variable stiffness segmentcomprises a plurality of variable stiffness segments that aresequentially arranged along the longitudinal axis. In certainembodiments, each variable stiffness segment of the plurality ofvariable stiffness segments is independently controllable. In certainembodiments, the compressible and/or extensible material includes a foammaterial. In certain embodiments, the at least one magneticallyresponsive element includes at least one metal element.

In certain embodiments, the guidewire device further includes aplurality of electrical conductors arranged in or on the tube andoperatively coupled with the at least one variable stiffness segment tosupply the at least one electrical signal. In certain embodiments, aplurality of circumferentially contractible fiber regions is arranged inor on the tube, wherein each circumferentially contractible fiber regionof the plurality of circumferentially contractible fiber regions islongitudinally spaced from each other circumferentially contractiblefiber region. In certain embodiments, a plurality of radiallycontractible fiber regions is arranged in or on the tube, wherein eachradially contractible fiber region of the plurality of radiallycontractible fiber regions is longitudinally spaced from each otherradially contractible fiber region. In certain embodiments, the tubeincludes a polymer adhesive, and the guidewire device includes at leastone electrical conductor configured to be coupled with an electric powersource for resistive heating of the polymer adhesive to adjust astiffness property of the polymer adhesive.

In another aspect, a guidewire device includes a tube having alongitudinal axis, a first end, a second end, and an interior; aplurality of body elements and a plurality of pivot joints sequentiallyarranged in a longitudinal direction within the interior of the tubebetween the first end and the second end, wherein each body element ofthe plurality of body elements is connected to at least one other bodyelement via at least one pivot joint of the plurality of pivot joints;and a plurality of tensile elements extending in the longitudinaldirection through the tube from the first end toward the plurality ofbody elements. Different tensile elements of the plurality of tensileelements terminate at different body elements of the plurality of bodyelements, and are separately operable to cause pivotal movement betweendifferent body elements of the plurality of body elements, therebypermitting adjustment of an angle or curvature of the guidewire deviceat multiple positions along the longitudinal axis.

In certain embodiments, the plurality of tensile elements includes atleast one agonist tensile element and at least one antagonist tensileelement, wherein the at least one antagonist tensile element isconfigured to be operated to counteract the at least one agonist tensileelement to control pivotal movement between different body elements ofthe plurality of body elements. In certain embodiments, the plurality oftensile elements are operatively connected to a plurality of tensioningelements configured to selectively apply tension to different tensileelements of the plurality of tensile elements. In certain embodiments,the plurality of tensioning elements are arranged beyond the first orsecond end of the tube.

In certain embodiments, a plurality of circumferentially contractiblefiber regions is arranged in or on the tube, wherein eachcircumferentially contractible fiber region of the plurality ofcircumferentially contractible fiber regions is longitudinally spacedfrom each other circumferentially contractible fiber region. In certainembodiments, each circumferentially contractible fiber region of theplurality of circumferentially contractible fiber regions comprises anelectrically responsive material selected from the group consisting of apiezoelectric material, an electroactive polymer, and a nitinol alloy.

In certain embodiments, a plurality of radially contractible fiberregions is arranged in or on the tube, wherein each radiallycontractible fiber region of the plurality of radially contractiblefiber regions is longitudinally spaced from each other radiallycontractible fiber region. In certain embodiments, each radiallycontractible fiber region of the plurality of radially contractiblefiber regions comprises an electrically responsive material selectedfrom the group consisting of a piezoelectric material, an electroactivepolymer, and a nitinol alloy.

In certain embodiments, the tube comprises a polymer adhesive, and theguidewire device includes at least one electrical conductor configuredto be coupled with an electric power source for resistive heating of thepolymer adhesive to adjust a stiffness property of the polymer adhesive.

In another aspect, a guidewire device includes a tubular body having alongitudinal axis, a first end, a second end, and an interior; aplurality of longitudinally contractible fiber regions arranged in or onthe tubular body, wherein each longitudinally contractible fiber regionof the plurality of longitudinally contractible fiber regions islaterally spaced from each other longitudinally contractible fiberregion; and a plurality of circumferentially contractible fiber regionsarranged in or on the tubular body, wherein each circumferentiallycontractible fiber region of the plurality of circumferentiallycontractible fiber regions is longitudinally spaced from each othercircumferentially contractible fiber region. Different longitudinallycontractible fiber regions of the plurality of longitudinallycontractible fiber regions are separately operable to adjust an angle orcurvature of the guidewire device between the first end and the secondend; and different circumferentially contractible fiber regions of theplurality of circumferentially contractible fiber regions are separatelyoperable to locally adjust a stiffness of the tubular body.

In certain embodiments, each circumferentially contractible fiber regionof the plurality of circumferentially contractible fiber regionsincludes an electrically responsive material selected from the groupconsisting of a piezoelectric material, an electroactive polymer, and anitinol alloy. In certain embodiments, each longitudinally contractiblefiber region of the plurality of longitudinally contractible fiberregions includes an electrically responsive material selected from thegroup consisting of a piezoelectric material, an electroactive polymer,and a nitinol alloy.

In certain embodiments, a plurality of radially contractible fiberregions are arranged in or on the tubular body, wherein each radiallycontractible fiber region of the plurality of radially contractiblefiber regions is longitudinally spaced from each other radiallycontractible fiber region. In certain embodiments, each radiallycontractible fiber region of the plurality of radially contractiblefiber regions includes an electrically responsive material selected fromthe group consisting of a piezoelectric material, an electroactivepolymer, and a nitinol alloy. In certain embodiments, the tubular bodyincludes a polymer adhesive, and the guidewire device includes at leastone electrical conductor configured to be coupled with an electric powersource for resistive heating of the polymer adhesive to adjust astiffness property of the polymer adhesive.

In another aspect, a guidewire device includes a tubular body having alongitudinal axis, a first end, a second end, and an interior; and aplurality of adjustable flexure elements arranged in or on the tubularbody; wherein the plurality of adjustable flexure elements areelectrically operable to adjust an angle or curvature of the guidewiredevice between the first end and the second end. In certain embodiments,the plurality of adjustable flexure elements includes at least one pairof adjustable flexure elements including first and second opposingflexure elements arranged at different lateral positions relative to thetubular body. In certain embodiments, the at least one pair ofadjustable flexure elements includes a first pair of adjustable flexureelements and a second pair of adjustable flexure elements, wherein thefirst pair of adjustable flexure elements and the second pair ofadjustable flexure elements are arranged at different longitudinalpositions relative to the tubular body.

In certain embodiments, each adjustable flexure element of the pluralityof adjustable flexure elements is electrically operable. In certainembodiments, each adjustable flexure element of the plurality ofadjustable flexure elements includes an electrically responsive materialselected from the group consisting of a piezoelectric material, anelectroactive polymer, and a nitinol alloy. In certain embodiments, eachadjustable flexure element of the plurality of adjustable flexureelements further includes a coating layer or backbone layer arranged incontact with the electrically responsive material. In certainembodiments, the guidewire device includes a plurality of conductors inelectrical communication with the plurality of adjustable flexureelements. In certain embodiments, at least one adjustable flexureelement of the plurality of adjustable flexure elements is independentlycontrollable relative to at least one other adjustable flexure elementof the plurality of adjustable flexure elements.

In certain embodiments, a plurality of circumferentially contractiblefiber regions is arranged in or on the tubular body, wherein eachcircumferentially contractible fiber region of the plurality ofcircumferentially contractible fiber regions is longitudinally spacedfrom each other circumferentially contractible fiber region. In certainembodiments, each circumferentially contractible fiber region of theplurality of circumferentially contractible fiber regions includes anelectrically responsive material selected from the group consisting of apiezoelectric material, an electroactive polymer, and a nitinol alloy.

In certain embodiments, a plurality of radially contractible fiberregions is arranged in or on the tubular body, wherein each radiallycontractible fiber region of the plurality of radially contractiblefiber regions is longitudinally spaced from each other radiallycontractible fiber region. In certain embodiments, each radiallycontractible fiber region of the plurality of radially contractiblefiber regions includes an electrically responsive material selected fromthe group consisting of a piezoelectric material, an electroactivepolymer, and a nitinol alloy. In certain embodiments, the tubular bodyincludes a polymer adhesive, and the guidewire device includes at leastone electrical conductor configured to be coupled with an electric powersource for resistive heating of the polymer adhesive to adjust astiffness property of the polymer adhesive.

In another aspect, a guidewire device includes a tube having alongitudinal axis, a first end, a second end, and an interior; aflexible guide wire or track arranged within the tube; and a pluralityof translatable elements arranged to independently translate along theflexible guide wire or track parallel to the longitudinal axis; whereineach translatable element of the plurality of translatable elements iselectrically operable to be translated in a longitudinal direction andthereby adjust a stiffness, angle, or curvature of the guidewire devicebetween the first end and the second end. In certain embodiments, eachtranslatable element of the plurality of translatable elements includesan electric motor unit.

In certain embodiments, the electric motor unit of each translatableelement of the plurality of translatable elements is controllable by asignal of a different frequency from each other electric motor unit ofthe guidewire device. In certain embodiments, the flexible guide wire ortrack includes a plurality of grooves or teeth, and each electric motorunit includes an engagement element arranged to engage with theplurality of grooves or teeth. In certain embodiments, the tube includesa polymer adhesive, and the guidewire device includes at least oneelectrical conductor configured to be coupled with an electric powersource for resistive heating of the polymer adhesive to adjust astiffness property of the polymer adhesive.

In another aspect, a guidewire device includes a tube having alongitudinal axis, a first end, a second end, and an interior; and aplurality of wires arranged in or on the tube. The tube includes apolymer adhesive, and at least one wire of the plurality of wires isconfigured to be coupled with an electric power source for resistiveheating of the polymer adhesive to adjust a stiffness property of thepolymer adhesive.

In certain embodiments, the plurality of wires includes braided wires ormultiple wires twisted about a core wire. In certain embodiments, eachwire of the plurality of wires includes at least one flat side surfacearranged to contact a flat side surface of another wire of the pluralityof wires. In certain embodiments, each wire of the plurality of wiresincludes a polygonal cross-sectional shape. In certain embodiments, eachwire of the plurality of wires includes a hexagonal cross-sectionalshape. In certain embodiments, at least some wires of the plurality ofwires comprise metal. In certain embodiments, at least some wires of theplurality of wires comprise conductive polymer material or compositematerial.

In certain embodiments, a guidewire device as disclosed herein includesa metal coil spring or flexible metal sheath extending generallyparallel to the longitudinal axis and surrounding at least a portion ofa tube or tubular element of the guidewire device.

In certain aspects, a diagnostic or therapeutic device includes acatheter as well as a guidewire device as disclosed herein, wherein thecatheter is configured to be advanced over the guidewire device.

In certain aspects, a method for diagnosis or therapeutic interventioncomprises insertion of a guidewire device as disclosed herein into alumen system of a mammalian (e.g., human or animal) body, followed byadvancement of a catheter over the guidewire device. During suchinsertion, one or more properties such as stiffness, angle, and/orcurvature of the guidewire device may be adjusted at one or morepositions between a distal end and proximal end thereof.

In certain aspects, any of the preceding aspects or other featuresdisclosed here may be combined for additional advantage.

Those skilled in the art will appreciate the scope of the presentdisclosure and realize additional aspects thereof after reading thefollowing detailed description of the preferred embodiments inassociation with the accompanying drawing figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a cross-sectional schematic view of a flexible guidewirebeing advanced past a first curve or bend of a vessel lumen.

FIG. 1B is a cross-sectional schematic view of the flexible guidewireand vessel lumen of FIG. 1A following advancement of the flexibleguidewire past a second curve or bend of the vessel lumen.

FIG. 10 is a cross-sectional schematic view of the flexible guidewireand vessel lumen of FIGS. 1A and 1B following advancement of a catheterover a portion of the flexible guidewire within the vessel lumen.

FIG. 2 is a side cross-sectional schematic view of a portion of aconventional flexible guidewire that includes a variable diameterlongitudinal core wire or mandrel and a flexible coil arranged over thecore wire or mandrel proximate to a distal tip of the guidewire.

FIG. 3 provides perspective, partial cross-sectional views of first andsecond conventional bundled wire systems each including multiple wireswith adhesive polymer between and around the wires.

FIG. 4 is a table depicting cross-sectional geometries and identifyingnumbers of wires and overall diameters for five different bundled wiresystem prototype designs A-E.

FIG. 5 is a perspective view of a pultruder used to make the bundledwire system prototype designs A-E described in connection with FIG. 4.

FIG. 6 is a schematic cross-sectional view of a die portion of thepultruder of FIG. 5.

FIG. 7A is a schematic cross-sectional view of a section of an exemplarybundled wire system including a biocompatible adhesive polymer arrangedbetween and around multiple wires.

FIG. 7B is a schematic elevation view of a section of another exemplarybundled wire system similar to the bundled wire system of FIG. 7A,following application of a polyolefin coating around a subassembly ofwires and polycaprolactone (PCL) upon exit from a pultruder.

FIG. 7C is a schematic elevation view of a section of another exemplarybundled wire system similar to the bundled wire system of FIG. 7A, inwhich wires and PCL are pushed through a coil spring while the wires andPCL are still warm.

FIG. 8A is a perspective view of a modeling diagram of the bundled wiresystem according to prototype design A described in connection with FIG.4, to permit finite element analysis (FEA) of the bundled wire system asa cantilever beam subject to bending.

FIG. 8B provides graphical FEA modeling results for the bundled wiresystem according to prototype design A of FIG. 8A in the stiff (cool)state.

FIG. 8C provides graphical FEA modeling results for the bundled wiresystem according to prototype design A of FIG. 8A in the floppy (warm)state.

FIG. 9A illustrates an INSTRON® materials testing machine used to applythree point bending to physical samples of bundled wire systemsdescribed herein.

FIG. 9B is a magnified view of a portion of the testing machine of FIG.9A.

FIG. 10 is a plot of load or force versus displacement for “no current”(corresponding to a stiff or cool state) and “current” (corresponding toa floppy or warm state) conditions, including predicted slope obtainedby FEA modeling and measured slope obtained by empirical testing for thebundled wire system according to prototype design A, including sevenwires and adhesive without any coating, as described in connection withFIG. 4.

FIG. 11 is a plot of load or force versus displacement for “no current”(corresponding to a stiff or cool state) and “current” (corresponding toa floppy or warm state) conditions, including predicted slope obtainedby FEA modeling and measured slope obtained by empirical testing for thebundled wire system according to prototype design B, including sevenwires and adhesive sheathed in polyolefin heat shrink tubing, asdescribed in connection with FIG. 4.

FIG. 12 is a plot of load or force versus displacement for “no current”(corresponding to a stiff or cool state) and “current” (corresponding toa floppy or warm state) conditions, including predicted slope obtainedby FEA modeling and measured slope obtained by empirical testing for thebundled wire system according to prototype design C, including nineteenwires and adhesive without any coating, as described in connection withFIG. 4.

FIG. 13 is a plot of load or force versus displacement for “no current”(corresponding to a stiff or cool state) and “current” (corresponding toa floppy or warm state) conditions, including predicted slope obtainedby FEA modeling and measured slope obtained by empirical testing for thebundled wire system according to prototype design D, including nineteenwires and adhesive sheathed in polyolefin heat shrink tubing, asdescribed in connection with FIG. 4.

FIG. 14 is a plot of load or force versus displacement for “no current”(corresponding to a stiff or cool state) and “current” (corresponding toa floppy or warm state) conditions, including predicted slope obtainedby FEA modeling and measured slope obtained by empirical testing for thebundled wire system according to prototype design E, including nineteenwires and adhesive sheathed in a stainless steel spring, as described inconnection with FIG. 4.

FIG. 15 is a plot of retained displacement (mm) versus startingdisplacement (mm) for bundled wire systems according to prototypedesigns A and C as described in connection with FIG. 4.

FIG. 16 is a table providing numerical results obtained by thedeformation-holding test described herein for bundled wire systemsaccording to prototype designs A and C as described in connection withFIG. 4.

FIG. 17 is a table summarizing numerical results of FEA modeled E_(f)(stiff state), tested (physical) E_(f) (stiff state), FEA modeled E_(f)(floppy state), tested (physical) E_(f) (floppy state), stiff statedisplacement at adhesion failure, stiff state radius of curvature atadhesion failure, force at stiff state adhesion failure, and minimumradius of curvature for bundled wire systems according to prototypedesigns A to E as described in connection with FIG. 4.

FIG. 18 is a table summarizing numerical results of flexural modulus andminimum radius of curvature without plastic deformation, as well asobservations as to whether shape is maintained during stiffness change,for bundled wire systems according to prototype designs A and C asdescribed in connection with FIG. 4.

FIG. 19 illustrates a bundled wire system including six wires eachhaving a hexagonal cross-sectional shape bundled around a central wirealso having the same shape, with polymer adhesive arranged around andbetween the wires and forming a generally tubular shape.

FIG. 20 illustrates a bundled wire system in which multiple wires ofround cross-sectional shapes are twisted about a central core wire, withpolymer adhesive preferably arranged around and between the wires.

FIG. 21 illustrates an external sheath of a commercially availableJOURNEY® guidewire.

FIG. 22A schematically illustrates a portion of a guidewire device inwhich stiffness at one or more locations may be adjusted by selectiveoperation or modulation of one or more electromagnetic elements,according to one embodiment of the present disclosure.

FIG. 22B schematically illustrates a portion of a guidewire device inwhich stiffness at one or more locations may be adjusted by selectiveoperation or modulation of one or more electromagnetic elements,including longitudinally extending conductors inset slightly relative toa tubular body, according to one embodiment of the present disclosure.

FIG. 23A is a schematic cross-sectional view of a portion of a guidewiredevice according to one embodiment in which angle or radius of curvatureat one or more locations may be adjusted by applying current toelectrically operable adjustable flexure elements arranged in or on atubular body, in which each flexure element of a pair of adjustableflexure elements is in a straightened state.

FIG. 23B is a schematic cross-sectional view of a portion of theguidewire device of FIG. 23A, in which the pair of adjustable flexureelements is curved to the left.

FIG. 23C is a schematic cross-sectional view of a portion of theguidewire device of FIG. 23A, in which the pair of adjustable flexureelements is curved to the right.

FIG. 24A is a simplified schematic cross-sectional illustration of aportion of a guidewire device according to one embodiment, includingmultiple pairs of electrically operable adjustable flexure elementsarranged at different locations in or on a tubular body around alongitudinally extended flexible core, wherein angle or radius ofcurvature at one or more locations may be adjusted by applying currentto the pairs of electrically operable adjustable flexure elements.

FIG. 24B is a first cross-sectional illustration of the guidewire deviceaccording to FIG. 24A, including a first pair of adjustable flexureelements.

FIG. 24C is a second cross-sectional illustration of the guidewiredevice of FIG. 24A, including a second pair of adjustable flexureelements.

FIG. 25 is a cross-sectional illustration of a portion of a guidewiredevice according to one embodiment similar to the device of FIGS.24A-24C, including multiple pairs of adjustable flexure elementsarranged in a tubular body with peripherally arranged electricalconductors, and with first and second pairs of adjustable flexureelements arranged at the same or a similar longitudinal position.

FIG. 26 is a cross-sectional illustration of a portion of a guidewiredevice according to one embodiment similar to the device of FIG. 25,including multiple pairs of adjustable flexure elements arranged in atubular body with medially arranged electrical conductors, and withfirst and second pairs of adjustable flexure elements arranged at thesame or a similar longitudinal position.

FIG. 27A is a simplified cross-sectional schematic illustration of aportion of a guidewire device including multiple body elements andmultiple pivot joints that are sequentially arranged in a longitudinaldirection within a tubular body, wherein each body element is connectedto at least one other body element via at least one pivot joint,according to one embodiment of the present disclosure.

FIG. 27B is a cross-sectional schematic illustration of the portion ofthe guidewire device corresponding to FIG. 27A, with addition of tensileelements extending in a longitudinal direction within the tubular body.

FIG. 27C is a cross-sectional schematic view of a portion of theguidewire device corresponding to FIG. 27B, while omitting one(antagonist) set of guidewires for clarity, and showing another(agonist) set of guidewires following application of tension.

FIG. 28A is a grid of (horizontally arranged) longitudinallycontractible fiber regions and (vertically arranged) circumferentiallycontractible fiber regions that may be incorporated into a guidewiredevice, according to one embodiment of the present disclosure.

FIG. 28B is a perspective view illustration of a tubular structure oflongitudinally contractible fiber regions and circumferentiallycontractible fiber regions obtained by rolling the grid of FIG. 28A intoa tubular shape, according to one embodiment of the present disclosure.

FIG. 28C is a cross-sectional view of a tubular body incorporating thetubular structure of FIG. 28B.

FIG. 29 is a cross-sectional illustration of at least a portion of aguidewire device similar to FIG. 28C, with addition of a longitudinallyextending flexible core according to one embodiment of the presentdisclosure.

FIG. 30 is a cross-sectional illustration of at least a portion of aguidewire device similar to FIG. 28C, with addition of a plurality ofradially contractible fiber regions arranged in or on the tubular bodyaccording to one embodiment of the present disclosure.

FIG. 31 is a cross-sectional schematic illustration of a portion of aguidewire device according to one embodiment of the present disclosure,including a longitudinal axis, a first end, a second end, and aninterior, with a centrally arranged flexible guide wire or trackarranged within the interior.

DETAILED DESCRIPTION

The present disclosure relates to guidewires that may be activelysteered and/or provide adjustable stiffness. The term “and/or” as usedherein encompasses either or all of multiple stated possibilities.Active steering may include adjustment of an angle and/or curvature of aguidewire at one or more locations between a first end and a second endthereof. Adjustable stiffness may include adjustment of flexural modulusat one or more locations between a first end and a second end thereof.

Guidewires as disclosed herein are intended and suitable for insertioninto a vessel lumen system of a mammalian (e.g., human) body, and toprovide a stable platform for advancement of catheters for performanceof diagnostic and/or therapeutic methods. During such insertion, one ormore properties such as stiffness, angle, and/or curvature of theguidewire may be adjusted at one or more positions between a distal endand proximal end thereof.

To investigate a potential mechanism of action for adjusting stiffness,bundled wire systems held together with low melting point polymeradhesive were modeled and separately tested. Stiffness of each bundlemay be controlled by resistive Joule heating, by applying electricalcurrent to the wires to soften (e.g., melt) the polymer adhesive. Whenin a cool state, a wire bundle is stiff since the polymer firmly couplesthe wires to one another. However, when heated to a warm state, a wirebundle is floppy in character, since the melted polymer softens andflows, thereby decoupling the wires and permitting the wires to adopt anew geometry.

Representative bundled wire systems 30, 40 are illustrated in FIG. 3. Atleft, FIG. 3 illustrates a bundled seven-wire system 30 with adhesivepolymer 32 between and around wires 34, 36, in which a group of sixperipheral wires 36 form a single-layer ring around a center wire 34. Atright, FIG. 3 illustrates a bundled nineteen-wire system 40 withadhesive polymer 42 between and around multiple wires 44, 46, 48, inwhich a first group of six wires 46 forms a first ring around a centerwire 44, and a second group of twelve wires 48 forms a second ringaround the first group of six wires 46, thus forming a double layerbundle. The wires 44, 46, 48 in the double layer bundle of thenineteen-wire system 40 at right are substantially smaller in diameterthan the wires 34, 36 in the single layer bundle of the seven-wiresystem 30 at left. In each instance, close-packed cylindrical bundlesare formed of concentric layers of straight wire, with each bundleincluding wires of uniform size. The stiffness range depends on thenumber of wires, wherein more wires yield a greater reduction instiffness, and the minimum radius of curvature depends on individualwire diameter.

FIG. 4 is a table identifying five different bundled wire systemprototype designs A to E. Each prototype design used steel music wire(ASTM 228), 0.015 inch (0.38 mm) individual wire diameter, 6 inches(15.2 cm) long, with properties similar to medical grade Type 304stainless steel as commonly used in guidewires. In each case, abiocompatible adhesive polymer (INSTAMORPH® polycaprolactone (Happy WireDog, LLC, Scottsdale, Ariz., US) or “PCL”) was used, with such materialexhibiting a low melting point of 60° C. A bundled wire system 50according to the design of Prototype A included seven wires (with sixperipheral wires 56 forming a single-layer ring around a center wire 54)embedded in adhesive polymer 52 with an overall diameter of 0.045 inch(1.14 mm). The bundled wire system 60 according to the design ofPrototype B included seven wires (with six peripheral wires 66 forming asingle-layer ring around a center wire 64) embedded in adhesive polymer62 and coated with polyolefin (PO) heat shrink tubing 65, yielding anoverall diameter of 0.067 inch (1.7 mm). The polyolefin heat shrinktubing 65 was intended to keep the wires 64, 66 bundled together underbending, and to resist the tendency for adhesion to fail. The bundledwire system 70 according to the design of Prototype C included nineteenwires (with a first group of six wires 76 forming a first ring around acenter wire 74, and a second group of twelve wires 78 forming a secondring around the first ring) embedded in adhesive polymer 72, with anoverall diameter of 0.075 inch (1.91 mm). The bundled wire system 80according to the design of Prototype D included nineteen wires (with afirst group of six wires 86 forming a first ring around a center wire84, and a second group of twelve wires 88 forming a second ring aroundthe first ring) embedded in adhesive polymer 82 and coated withpolyolefin heat shrink tubing 87, yielding an overall diameter of 0.091inch (2.31 mm). The bundled wire system 90 according to the design ofPrototype E included 19 wires (with a first group of six wires 96forming a first ring around a center wire 94, and a second group oftwelve wires 98 forming a second ring around the first ring) embedded inadhesive polymer 92 and wrapped with a stainless steel spring 99,yielding an overall diameter of 0.125 inch (3.18 mm).

The minimum radius (p) of curvature achievable by a wire bundle whenbent was calculated as equal to the minimum radius of curvatureachievable by the innermost wire before plastically deforming (in otherwords, when the maximum axial stress in the material reached its yieldstress). The minimum radius (p) of curvature is calculated as theproduct of the flexural modulus of the wire material and the radius ofthe individual wire, divided by the yield stress.

FIG. 5 depicts a pultruder 100 used to make prototypes of bundled wiresystems according to the prototype designs A to E described hereinabove.The pultruder 100 includes a support rod 102 and an adjustable heightlinkage 104 with a shelf 106 that supports a heated die portion 110,with a clamp 108 affixing a die 112 to the shelf 106. The pultruder 100is configured to receive wires 134 from above, contain molten materialtherein, and eject a cylindrical wire bundle at bottom. FIG. 6 is aschematic cross-sectional view of the heated die portion 110 of thepultruder 100 of FIG. 5. Referring to FIG. 6, the heated die portion 110includes the die 112, which is fabricated of aluminum and has asubstantially cylindrical outer wall 114 surrounded at least in part bya peripheral heating collar 126 that is configured to supply heat to thedie 112. The die 112 further includes a cavity 122 bounded by an upperor entrance opening 116, a tapered lower wall 118, and a lower or exitopening 120. In use, straight wires 134 are fed through the upper orentrance opening 116 and into the cavity 122 of the die 112 to contactmolten PCL 124 contained therein. Feedback control of temperature isprovided with a thermocouple 129 in conductive communication with thedie 112. When the wires 134 are fed into the die 112, molten PCL 124coats the wires 134 externally and therebetween, and as the wires 134are pulled through the lower or exit opening 120, the wires 134 andsolidified PCL 132 form a cylindrical bundle 130 having the samediameter as the lower or exit opening 120. Specifically, the close fitof the lower or exit opening 120 packs the wires 134 together into thecylindrical bundle 130, which is held together by solidified PCL 132(i.e., that solidifies from molten PCL 124 as it cools).

Three different bundled wire system configurations obtainable at leastin part using the pultruder 100 and heated die portion 110 illustratedin FIGS. 5 and 6 are schematically illustrated in FIGS. 7A to 7C. FIG.7A illustrates an exemplary bundled wire system 130 obtained by feedingmultiple wires 134 through a pultruder 100 and permitting PCL 132 tocool around and between the wires 134. FIG. 7B illustrates an exemplarybundled wire system 140 similar to the bundled wire system 130 of FIG.7A, but following application of a polyolefin coating 137 (e.g., in theform of heat shrink tubing) around an exterior of PCL 132 and wires 134upon exit from a pultruder (not shown). More specifically, a section oftubing 137′ may receive heat H from a heat source (not shown) to causethe tubing 137′ to contract and form the polyolefin coating 137. FIG. 7Cillustrates an exemplary bundled wire system 141 similar to the bundledwire system 130 of FIG. 7A, wherein the wires 134 and PCL 132 exiting apultruder (not shown) are pushed through a coil spring 139 while thewires 134 and PCL 132 are still warm.

Examples of the above-described five different bundled wire systems 50,60, 70, 80, 90 according to prototype designs A to E were subjected tofinite element analysis (FEA) modeling to provide predicted performanceas well as physical analysis to yield measured performance. FIG. 8A is aperspective view modeling diagram of the bundled wire system 50according to prototype design A, following finite element analysis as acantilever beam subject to bending (with one end fixed and the other endfree). A beam length of 0.02 meters and an applied load of 0.05 Newtonswere used, with the model being used to measure displacement D of thefree end under application of an edge load F to determine flexuralmodulus in stiff and floppy states, to permit calculation of flexuralmodulus (equal to the product of the edge load F times the length of thebeam L cubed, divided by three times the product of the second areamoment of inertia and the displacement). FIG. 8B provides graphical FEAmodeling results (including deformation as a function of position) forthe bundled wire system 50 according to prototype design A in the stiff(cool) state, and FIG. 8C provides graphical FEA modeling results forthe bundled wire system 50 according to prototype design A in the floppy(warm) state. FIGS. 8B and 8C embody diagrams converted from color tograyscale, and in each figure, letter codes have been added to thefigure and corresponding legend to permit visualization of flexuralmodulus values as follows: R=red, O=orange, Y=yellow, G=green, LB=lightblue, and B=blue. The modulus of elasticity E_(f) was reduced from 134GPa in the stiff (cool) state (shown in FIG. 8B) to less than 17 GPa inthe floppy (warm) state (shown in FIG. 8C).

FIG. 9A illustrates an INSTRON® materials testing machine 150 (IllinoisTool Works Inc., Glenview, Ill., US), and FIG. 9B illustrates amagnified portion of the same machine 150, used to apply three pointbending to physical samples using an upper cylindrical roller 151configured to translate downward and apply a force F along a centerlinebetween two lower cylindrical rollers 152, 153 spaced apart by adistance L. In one set of tests, the force F required to attain adisplacement D was measured in order to determine the flexural modulusE_(f) of a prototype bundled wire system, with determination of F and Dwhen the prototype fails. A length L of 0.04 meter between the lowercylindrical rollers 152, 153 was used. The flexural modulus for a beamsubjected to three-point bending is calculated as the applied forcetimes the length cubed, divided by forty-eight times the product of thesecond area moment of inertia and the diameter. Each prototype bundledwire system 50, 60, 70, 80, 90 according to prototype designs A to E wastested in a stiff state (cool, with no electric current) and a floppystate (in which electric current was applied to the core wires to heatthe sample). Another protocol using the same INSTRON® materials testingmachine 150 was used to perform a deformation-holding test on eachprototype bundled wire system 50, 60, 70, 80, 90, with thedeformation-holding test serving to measure the extent to which thebundled wire system 50, 60, 70, 80, 90 held its deformed shape (andtherefore resisted straightening due to internal stresses of bent wires)after cooling. The idea is to determine the minimum bending radius thatthe thermoplastic adhesive can sustain without failing. In each case, aprototype bundled wire system 50, 60, 70, 80, 90 was subjected tothree-point bending, whereby the bundled wire system was bent to aprescribed displacement when in the floppy (warm) state, then allowed tocool while displaced/loaded, followed by removal of the load.Thereafter, the displacement to which the bundled wire system springsback was measured, and scrutiny was applied to observe any adhesionfailure. The minimum radius of curvature for any given displacement D atthe midpoint is calculated as the length squared divided by twelve timesthe displacement D.

FIGS. 10-14 are plots of load or force F (in Newtons) versusdisplacement D (in millimeters), for “no current” (corresponding to astiff or cool state) and “current” (corresponding to a floppy or warmstate) conditions, including predicted slope obtained by FEA modelingand measured slope obtained by empirical testing (with an INSTRON®materials testing machine as outlined above), for the bundled wiresystems 50, 60, 70, 80, 90 according to prototype designs A to E(illustrated and described in connection with FIG. 4), respectively. Theslope of each line corresponds to flexural modulus E_(f). FIG. 10provides results for the bundled wire system 50 according to Prototypedesign A including seven wires and adhesive without any coating.Adhesion among wires in the bundled wire system 50 failed at around 0.48mm at a force of approximately 2.8N (indicated by the arrow at left).FIG. 11 provides results for the bundled wire system 60 according toPrototype B, including seven wires and adhesive sheathed in polyolefinheat shrink tubing. Adhesion among wires in the bundled wire system 60failed at around 0.37 mm at a force of approximately 2.0N (indicated bythe arrow at left). FIG. 12 provides results for the bundled wire system70 according to Prototype C, including nineteen wires and adhesivewithout any coating. Adhesion among wires in the bundled wire system 70failed at around 0.435 mm at a force of approximately 13.2N (indicatedby the arrow at left). FIG. 13 provides results for the bundled wiresystem 80 according to Prototype D including nineteen wires and adhesivesheathed in polyolefin heat shrink tubing. Adhesion among wires in thebundled wire system 80 failed at around 0.28 mm at a force ofapproximately 7.2N (indicated by the arrow at left). FIG. 14 providesresults for the bundled wire system 90 according to Prototype Eincluding nineteen wires and adhesive sheathed in a 0.125 inch (3.18 mm)stainless steel spring. Adhesion among wires in the bundled wire system90 failed at around 0.15 mm at a force of approximately 11.2N (indicatedby the arrow at left).

In each of FIGS. 10-14, the “no current” or stiff (cool) state providesa substantially greater flexural modulus E_(f) value than the “current”or floppy (warm) state. Upon review of FIGS. 10-14, it is apparent thatthe “cool” wire bundles exhibit two slopes, including a high stiffnessregion characterized by a steep slope for up to about 0.5 mm untiladhesion suddenly fails, and a low stiffness region characterized by ashallow slope in which stiffness is roughly equivalent to the “warm” orfloppy state. Observation and inspection of the wires during and afterthis sudden change in slope showed that the wires and polymer adhesiveindeed separated. Neither the polyolefin heat shrink tubing nor thestainless steel spring appeared to prevent or delay the onset ofdelamination; however, the stainless steel spring did keep the bundledwire system's circular cross-sectional shape from deforming, in contrastto all of the other prototypes A to D, which exhibited a flattenedcross-section at the point where load was applied. All tested wires heldtheir deformed shape when cooled from the warm state while held inposition under load, and this could be reversed by reheating the wireelectrically. There was a limit to how much bend a wire could holdwithout breaking the adhesion, and each wire exhibited a tendency tospring back. Each bundled wire system prototype would not straightenmore when allowed to cool.

FIG. 15 is a plot of retained displacement (mm) versus startingdisplacement (mm) for bundled wire systems 50, 70 according to prototypedesigns A and C, and FIG. 16 is a table providing numerical results forthe same bundled wire systems 50, 70 according to prototype designs Aand C, obtained by the deformation-holding test described hereinabove.As shown in FIGS. 15 and 16, the bundled wire system prototypes 50, 70can maintain some of the deformation/curvature they have undergone whencooled, up to a certain displacement. The solidified polymer adhesiveresists some but not all of the straightening of the steel wires. Pastthis displacement, the bundled wire system prototypes 50, 70 lose theability to maintain deformation/curvature in the cold state due toadhesion failure. In particular, the polymer adhesive peels from themetal, and the adhesion strength is not sufficient to resist thestraightening of the wires without breaking.

FIG. 17 is a table summarizing numerical results of FEA modeled E_(f)(stiff state), tested (physical) E_(f) (stiff state), FEA modeled E_(f)(floppy state), tested (physical) E_(f) (floppy state), stiff statedisplacement at adhesion failure, stiff state radius of curvature atadhesion failure, force at stiff state adhesion failure, and minimumradius of curvature for bundled wire systems 50, 60, 70, 80, 90according to prototype designs A to E (illustrated and described inconnection with FIG. 4). In general, the FEA models appear to accuratelypredict E_(f) values of the prototypes A to E in the floppy state,thereby suggesting that in the floppy state, each bundled wire systemprototype 50, 60, 70, 80, 90 behaves as a bundle of uncoupled wires.However, the FEA models generally overestimate E_(f) values for thebundled wire system prototypes 50, 60, 70, 80, 90 in the stiff state.This may suggest that the effective E_(f) value of the polymer adhesiveis less than the literature value used in the FEA model, and/or it maysuggest the possible existence of voids between the wires in whichpolymer adhesive is absent, thereby decreasing adhesion strength andlowering the effective stiffness of the PCL between the wires.

FIG. 18 is a table summarizing numerical results of flexural modulus andminimum radius of curvature without plastic deformation, as well asobservations as to whether shape is maintained during stiffness change,for bundled wire systems 50, 70 according to prototype designs A and C.

The preceding disclosure including FIGS. 3 to 18 demonstrates theviability of bundled wire systems as prototypes for guidewires havingstiffness properties that can be changed by coupling at least oneelectrical conductor (e.g., one or more bundled wire systems) with anelectric power source for resistive heating of a polymer adhesivebinding the wires, by which a stiffness property of the polymer adhesivemay be adjusted. Although adhesion between wires was not necessarilyimproved by external application of polyolefin coatings or helical coilsprings, the use of coil springs did preserve the circular cross-sectionof a wire bundle, which would tend to permit advancement of a catheterutilizing a bundled wire system (as opposed to potential jamming of acatheter during advancement over a guidewire if a bundle of wires wereflattened in shape). Wires within a bundle tend to straighten in a coolstate, but, unlike moveable core wires of a conventional moveableguidewire, a bundled wire system guidewire as described in connectionwith the foregoing figures would not apply more straightening forceagainst vessel walls when stiffness is increased.

Consistent with the foregoing disclosure, in one aspect, the presentdisclosure relates to a guidewire device including a tube having alongitudinal axis, a first end, a second end, and an interior; andincluding a plurality of wires arranged in or on the tube; wherein thetube comprises a polymer adhesive, and at least one wire of theplurality of wires is configured to be coupled with an electric powersource for resistive heating of the polymer adhesive to adjust astiffness property of the polymer adhesive. In certain embodiments, atleast some wires of the plurality of wires include metal. In certainembodiments, at least some wires of the plurality of wires includeconductive polymer material or composite material. In certainembodiments, combinations of wires including metal and wires includingconductive polymer and/or composite materials may be used.

To address certain issues experienced with use of bundled wire systemguidewire prototypes including parallel wires of round cross-sectionalshapes, other wire shapes and/or orientations may be used. For example,FIG. 19 illustrates a bundled wire system 160 including six wires 166each having a hexagonal cross-sectional shape bundled around a centralwire 164 also having the same shape, with polymer adhesive 162 arrangedaround and between the wires 164, 166 and forming a generally tubularshape. More generally, in certain embodiments, each wire of a pluralityof wires may include a polygonal cross-sectional shape, or may includeat least one flat side surface (preferably multiple flat side surfaces)arranged to contact a flat side surface of another adjacent wire. Asanother example, FIG. 20 illustrates a bundled wire system 170 in whichmultiple (e.g., six) wires 176 of round cross-sectional shapes aretwisted about a central core wire 174, with polymer adhesive 172preferably arranged around and between the wires 174, 176.Alternatively, multiple wires may be braided. The precedingconformations may assist in maintaining wires in a generally roundbundle even when a polymer adhesive contacting the wires is in asoftened (e.g., warm and “floppy”) state.

In certain embodiments, guidewire devices as disclosed herein mayinclude a metal coil spring extending generally parallel to alongitudinal axis of a tube or tubular body, and surrounding at least aportion of the tube or tubular body. In other embodiments, guidewiredevices as disclosed herein may include a flexible metal sheathextending generally parallel to a longitudinal axis of a tube or tubularbody, and surrounding at least a portion of the tube or tubular body.Such a coil spring or flexible metal sheath may embody an outer surfaceof a guidewire. One example of a flexible metal sheath 180 is shown inFIG. 21, which depicts an external sheath of a JOURNEY® guidewire(Boston Scientific Scimed, Inc., Maple Grove, Minn., US). In certainembodiments, a metal coil spring or flexible metal sheath may be used inlieu of a wire bundle within a tube, with the potential of providingimproved bidirectional torque transmission.

FIG. 22A schematically illustrates a portion of a guidewire device 190in which stiffness at one or more locations may be adjusted by selectiveoperation or modulation of one or more electromagnetic elements. Theguidewire device 190 includes a tubular body (e.g., a tube) 191including multiple variable stiffness segments 192A, 192B that may beseparated by segments 199 lacking variable stiffness capability. In eachvariable stiffness segment 192A, 192B, a compressible and/or extensiblematerial 193A, 193B is arranged between an electromagnet 194A, 194B andat least one magnetically responsive element 197A, 197B. Theelectromagnet 194A, 194B is configured to receive at least oneelectrical signal to selectively generate a magnetic field sufficient tointeract with the at least one magnetically responsive element 197A,197B, thereby exerting a compression or extension force on thecompressible and/or extensible material 193A, 193B to adjust a stiffnessof the variable stiffness segment 192A, 192B. In certain embodiments,when an electromagnet 194A, 194B is energized to exert an attractiveforce on at least one magnetically responsive element 197A, 197B (e.g.,a metal such as carbon steel) separated therefrom by a compressibleand/or extensible material 193A, 193B, the resulting attraction (asindicated by the vertically arranged arrows shown in FIG. 22A) tends tocompress the compressible and/or extensible material 193A, 193B, therebyincreasing stiffness of the variable stiffness segment(s) 192A, 192B. Incertain embodiments, when an electromagnet 194A, 194B is energized toexert a repelling force on at least one magnetically responsive element197A, 197B (e.g., a magnet or another electromagnet of the samepolarity), the resulting repulsion tends to elongate or extend thecompressible and/or extensible material 193A, 193B, thereby decreasingstiffness of the variable stiffness segment(s) 192A, 192B.

FIG. 22B schematically illustrates a portion of another guidewire device200 in which stiffness at one or more locations may be adjusted byselectively operation or modulation of one or more electromagneticelements 204A, 204B. The guidewire device 200 includes a tubular body(e.g., a tube) 201 including multiple variable stiffness segments 202A,202B, with longitudinally extending conductors 208-1, 208-2 insetslightly relative to the tubular body 201. In each variable stiffnesssegment 202A, 202B, a compressible and/or extensible material 203A, 203Bis arranged between an electromagnetic element 204A, 204B and at leastone magnetically responsive element 207A, 207B. Each electromagneticelement 204A, 204B includes contact regions 205A, 205B, 206A, 206Barranged for conductive electrical communication with the longitudinallyextending conductors 208-1, 208-2. In certain embodiments, one or morecontact regions 205A, 205B, 206A, 206B may include switching or gatingelements arranged to control flow of current through an electromagneticelement 204A, 204B. In certain embodiments, each variable stiffnesssegment 202A, 202B may include one or more dedicated electricalconductors and/or each variable stiffness segment 202A, 202B may beindependently controlled. In certain embodiments, each variablestiffness segment 202A, 202B may be separated from one another by atleast one segment 209 lacking variable stiffness capability.

With respect to FIGS. 22A and 22B, in certain embodiments, thecompressible and/or extensible material 193A, 193B, 203A, 203B includesa foam material, which may embody a three-dimensional matrix. In certainembodiments, multiple variable stiffness segments 192A, 192B, 202A, 202Bmay be sequentially arranged along the longitudinal axis of a guidewiredevice 190, 200, and may be independently controlled. In certainembodiments, longitudinally extending conductors (e.g., 208-1, 208-2)may be arranged in or on the tubular body structure 191, 201 andoperatively coupled with one or more variable stiffness segments 192A,192B, 202A, 202B (e.g., including electromagnetic elements thereof) tosupply electrical signals for adjusting stiffness. In certainembodiments, a tubular body 191, 201 may comprise a polymer adhesive,and a guidewire 190, 200 may include at least one electrical conductorconfigured to be coupled with an electric power source (not shown) forresistive heating of the polymer adhesive to adjust a stiffness propertyof the polymer adhesive. In certain embodiments, a plurality ofcircumferentially contractible fiber regions (e.g., piezoelectricmaterial, an electroactive polymer, or a nitinol alloy, not shown butdescribed hereinafter in connection with FIGS. 28A-30) may be arrangedin or on the tubular body 191, 201, wherein each circumferentiallycontractible fiber region is longitudinally spaced from each othercircumferentially contractible fiber region. In certain embodiments, aplurality of radially contractible fiber regions (not shown, butdescribed hereinafter in connection with FIGS. 28A-30) may be arrangedin or on the tubular body 191, 201, wherein each radially contractiblefiber region (e.g., piezoelectric material, an electroactive polymer, ora nitinol alloy) is longitudinally spaced from each other radiallycontractible fiber region. If provided, each circumferentiallycontractible fiber region or radially contractible fiber region mayfurther permit adjustment of stiffness and/or aid in steering in one ormore regions of the guidewire element. In certain embodiments, a metalcoil spring or flexible metal sheath (not shown, but describedpreviously herein) may extend generally parallel to the longitudinalaxis and surround at least a portion of the tubular body.

FIGS. 23A-23C provide schematic cross-sectional views of a portion of aguidewire device 210 in which angle or radius of curvature at one ormore locations may be adjusted by applying current to electricallyoperable adjustable flexure elements 212, 212′ arranged in or on atubular body 211. FIGS. 23A-23C each illustrates a pair of adjustableflexure elements 212, 212′ that are longitudinally oriented proximate tosides of the tubular body 211. Each adjustable flexure element 212, 212′may include a coating layer or backbone layer 213, 213′ (e.g., a metal)arranged in contact with an electrically responsive material 214, 214′(e.g., a piezoelectric material, an electroactive polymer, or a nitinolalloy) that contracts, bends, or straightens with application ofdifferent voltage. The metal coating layer or backbone layer 213, 213′may be used to adjust rigidity or compliance of the adjustable flexureelement 212, 212′. In certain embodiments, for each adjustable flexureelement 212, 212′, the electrically responsive material 214, 214′ may bemedially located, and the coating layer or backbone layer 213, 213′ maybe located closer to an outer surface of the tubular body 211.Preferably, electrical conductors (not shown in FIGS. 23A and 23B, butshown in FIGS. 24B, 24C, 25, and 26) are arranged in electricalcommunication with the adjustable flexure elements 212, 212′. In certainembodiments, at least one adjustable flexure element 212, 212′ of thepair of adjustable flexure elements 212, 212′ is independentlycontrollable relative to at least one other adjustable flexure element212, 212′ of the pair of adjustable flexure elements 212, 212′. FIG. 23Ashows the pair of adjustable flexure elements 212, 212′ in astraightened state. FIG. 23B shows the pair of adjustable flexureelements 212, 212′ each curved to the left, and FIG. 23C shows the pairof adjustable flexure elements 212, 212′ each curved to the right.

FIG. 24A is a simplified schematic cross-sectional illustration of aportion of another guidewire device 220 in which angle or radius ofcurvature at one or more locations may be adjusted by applying currentto electrically operable adjustable flexure elements 222A, 222A′, 222Barranged in or on a tubular body 221. Each adjustable flexure element(e.g., 222A, 222A′, 222B) includes a coating layer or backbone layer223A, 223A′, 223B (e.g., a metal) arranged in contact with anelectrically responsive material 224A, 224A′ (e.g., a piezoelectricmaterial, an electroactive polymer, or a nitinol alloy). Multiple (e.g.,first and second) pairs of adjustable flexure elements are provided,wherein each pair of adjustable flexure elements includes first andsecond opposing flexure elements arranged at different lateral positionsrelative to the tubular body 221. The second pair of flexure elements(including flexure element 222B and a corresponding flexure element, notshown) is arranged at a different longitudinal position along thetubular body 221 relative to the first pair of opposing flexure elements(222A, 222A′). As shown in FIG. 24A, the tubular body 221 includes alongitudinally extending flexible core 225, such as may include one ormore wires, fibers, or similar elements. In certain embodiments, theflexible core 225 comprises an electrically conductive material (e.g.,including one or more metal-containing wires) to enable resistiveheating of the tubular body 221 to permit softening of the tubular body221 to affect its stiffness properties. Although electrical conductorsare not shown in FIG. 24A, it is to be appreciated that electricalconductors extending in a generally longitudinal direction may beoperatively coupled to each adjustable flexure element 222A, 222A′,222B. FIG. 24B is a first cross-sectional illustration of the guidewiredevice 220 according to FIG. 24A, including a first pair of adjustableflexure elements 222A, 222A′ each including two layers of material, suchas a metal coating or backbone layer 223A, 223A′ each arranged incontact with an electrically responsive adjustable flexure layer 224A,224A′, with a first group of electrical conductors 226 being configuredto conduct electrical signals to one flexure layer 224A, and a secondgroup of electrical conductors 226′ being configured to conductelectrical signals to another flexure layer 224A′. FIG. 24B also showsthe longitudinally extending flexible core 225 (e.g., one or more wires,fibers, or similar elements) centrally arranged within the tubular body221. FIG. 24C is a second cross-sectional illustration of the guidewiredevice 220 of FIG. 24A, showing the core member 225 as well as thetubular body 221 containing a second pair of adjustable flexure elements222B, 222B′ each including two layers of material, such as a metalcoating or backbone layer 223B, 223B′ arranged in contact with anelectrically responsive adjustable flexure layer 224B, 2246′, with thefirst group of electrical conductors 226 being configured to conductelectrical signals to one flexure layer 224B, and the second group ofelectrical conductors 226′ being configured to conduct electricalsignals to the other flexure layer 2246′. The resulting guidewire device220 permits each pair of adjustable flexure elements 224A-224A′,224B-224B′ (and preferably each individual adjustable flexure element224A, 224A′, 224B, 2246′) to be independently operated to enableadjustment of angle and/or curvature of the guidewire device 220 atmultiple positions along its length. Although only two pairs ofadjustable flexure elements 224A-224A′, 224B-224B′ are shown in FIG. 24Ato 24C, it is to be appreciated that any suitable number of two, three,four, five or more pairs of adjustable flexure elements may be provided.

Consistent with the preceding discussion of FIGS. 23A-24C, in certainembodiments, a guidewire device includes a tubular body having alongitudinal axis, a first end, a second end, and an interior; and aplurality of adjustable flexure elements arranged in or on the tubularbody; wherein the plurality of adjustable flexure elements areelectrically operable to adjust an angle or curvature of the guidewiredevice between the first end and the second end. In certain embodiments,a plurality of circumferentially contractible fiber regions (e.g., apiezoelectric material, an electroactive polymer, or a nitinol alloy,not shown but described hereinafter in connection with FIGS. 28A-30) maybe arranged in or on the tubular body, wherein each circumferentiallycontractible fiber region of the plurality of circumferentiallycontractible fiber regions is longitudinally spaced from each othercircumferentially contractible fiber region. In certain embodiments, aplurality of radially contractible fiber regions (e.g., a piezoelectricmaterial, an electroactive polymer, or a nitinol alloy, not shown butdescribed hereinafter in connection with FIGS. 28A-30) may be arrangedin or on the tubular body, wherein each radially contractible fiberregion of the plurality of radially contractible fiber regions islongitudinally spaced from each other radially contractible fiberregion. In certain embodiments, the tubular body includes a polymeradhesive, and the guidewire device includes at least one electricalconductor configured to be coupled with an electric power source forresistive heating of the polymer adhesive to adjust a stiffness propertyof the polymer adhesive.

FIG. 25 is a cross-sectional illustration of a portion of anotherguidewire device 230 (similar to the device 220 of FIGS. 24A-24C)including multiple pairs of adjustable flexure elements 232A-232A′,232B-232B′ arranged in a tubular body 231, wherein first and secondpairs of adjustable flexure elements 232A-232A′, 232B-232B′ are arrangedat the same or a similar longitudinal position. Each pair of adjustableflexure elements 232A-232A′, 232B-232B′ includes first and secondopposing flexure elements 232A-232A′, 232B-232B′ arranged at differentlateral positions relative to the tubular body 231. Each adjustableflexure element 232A, 232A′, 232B, 232B′ may include a coating layer orbackbone layer 233A, 233A′, 233B, 233B′ (e.g., a metal) arranged incontact with an electrically responsive material 234A, 234A′, 234B,234B′ (e.g., a piezoelectric material, an electroactive polymer, or anitinol alloy). As shown in FIG. 25, the tubular body 231 includes alongitudinally extending flexible core 235 (such as may include one ormore wires, fibers, or similar elements) and further includesperipherally arranged groups of electrical conductors 236, 236′extending in a generally longitudinal direction, with differentelectrical conductors being operatively coupled with one or moredifferent adjustable flexure elements 232A, 232A′, 232B, 2326′.

FIG. 26 is a cross-sectional illustration of a portion of anotherguidewire device 240 (similar to the device 240 of FIG. 25) includingmultiple pairs of adjustable flexure elements 242A-242A′, 242B-242B′arranged in a tubular body 241, wherein first and second pairs ofadjustable flexure elements 242A-242A′, 242B-242B′ are arranged at thesame or a similar longitudinal position. Each pair of adjustable flexureelements 242A-242A′, 242B-242B′ includes first and second opposingflexure elements 242A, 242A′, 242B, 242B′ arranged at different lateralpositions relative to the tubular body 241. Each adjustable flexureelement 242A, 242A′, 242B, 242B′ may include a coating layer or backbonelayer 243A, 243A′, 243B, 243B′ (e.g., a metal) arranged in contact withan electrically responsive material 244A, 244A′, 244B, 244B′ (e.g., apiezoelectric material, an electroactive polymer, or a nitinol alloy).As shown in FIG. 25, the tubular body 241 includes a longitudinallyextending flexible core 245 (such as may include one or more wires,fibers, or similar elements) and further includes groups of electricalconductors 246, 246′ extending in a generally longitudinal direction,with different electrical conductors 246, 246′ being operatively coupledwith one or more different adjustable flexure elements 242A, 242A′,242B, 2426′, wherein the electrical conductors 246, 246′ are arrangedgenerally between the flexible core 245 and the adjustable flexureelements 242A, 242A′, 242B, 2426′.

FIG. 27A is a simplified cross-sectional schematic illustration of aportion of a guidewire device 250 including multiple (e.g., four) bodyelements 252A-252D and multiple (e.g., three) pivot joints 253A-253Cthat are sequentially arranged in a longitudinal direction within atubular body 251 (e.g., a tube), wherein each body element 252A-252D isconnected to at least one other body element 252A-252D via at least onepivot joint 253A-253C. In certain embodiments, each pivot joint253A-253C may include a ball and socket joint. FIG. 27B is across-sectional schematic illustration of the portion of the guidewiredevice 250 of FIG. 27A, with addition of tensile elements 255A-1,255B-1, 255C-1, 255D-1, 255A-2, 255B-2, 255C-2, 255D-2 extending in alongitudinal direction within the tubular body structure 251. In certainembodiments, the tensile elements 255A-1, 255B-1, 255C-1, 255D-1,255A-2, 255B-2, 255C-2, 255D-2 include wires, filaments, strands,fibers, or the like. In certain embodiments, tensile elements 255A-1,255B-1, 255C-1, 255D-1, 255A-2, 255B-2, 255C-2, 255D-2 may include metalwires and/or fibrous strands of material such as small diameter fishingline. In certain embodiments, gel-spun polyethylene may be used, such asBerkley NanoFil monofilament/braid hybrid line, commercially availablein a diameter as small as 0.008 inch (0.2 mm). Different tensileelements 255A-1, 255B-1, 255C-1, 255D-1, 255A-2, 255B-2, 255C-2, 255D-2terminate at different body elements 252A-252D, and are separatelyoperable to cause pivotal movement of different body elements 252A-252D,thereby permitting adjustment of an angle or curvature of the guidewiredevice 250 at multiple positions along the longitudinal axis. In certainembodiments, the tensile elements 255A-1, 255B-1, 255C-1, 255D-1,255A-2, 255B-2, 255C-2, 255D-2 are operatively connected to a pluralityof tensioning elements (e.g., motors, solenoids, actuators, or the like;not shown) configured to selectively apply tension to different tensileelements 255A-1, 255B-1, 255C-1, 255D-1, 255A-2, 255B-2, 255C-2, 255D-2.In certain embodiments, the plurality of tensioning elements is arrangedbeyond the first or second end of the tubular body structure 251.Certain tensile elements 255A-1, 255B-1, 255C-1, 255D-1 may be arrangedin a first tensile element group 255-1, and other tensile elements255A-2, 255B-2, 255C-2, 255D-2 may be arranged in a second tensileelement group 255-2.

In certain embodiments, the tensile elements 255A-1, 255B-1, 255C-1,255D-1, 255A-2, 255B-2, 255C-2, 255D-2 include at least one agonisttensile element (or group thereof, such as the second tensile elementgroup 255-2) and at least one antagonist tensile element (or groupthereof, such as the first tensile element group 255-1), wherein the atleast one antagonist tensile element is configured to be operated tocounteract the at least one agonist tensile element to control pivotalmovement between different body elements 252A-252D. FIG. 27B shows thetensile elements 255A-1, 255B-1, 255C-1, 255D-1, 255A-2, 255B-2, 255C-2,255D-2 without application of tensile force, with the guidewire device250 in a straight configuration. FIG. 27C is a cross-sectional schematicillustration of a portion of the guidewire device 250 corresponding toFIG. 27B, while omitting (for clarity) the first tensile element group255-1 of FIG. 27B that may serve as an antagonist tensile element, andshowing the second tensile element group 255-2 serving as an agonisttensile element following application of tension (according to thetension profile at bottom) to the tensile elements 255A-2, 255B-2,255C-2, 255D-2 using multiple tensioning elements (not shown). Selectiveapplication of tension to different tensile elements 255A-1, 255B-1,255C-1, 255D-1, 255A-2, 255B-2, 255C-2, 255D-2 or groups thereof permitspivotal movement between different body elements 252A-252D, therebypermitting angle and/or curvature of the guidewire device 250 to beadjusted, preferably at multiple positions along its length.

With further reference to FIGS. 27B and 27C, in certain embodiments, aplurality of circumferentially contractible fiber regions (not shown butdescribed hereinafter in connection with FIGS. 28A-30) is arranged in oron the tubular body structure 251, wherein each circumferentiallycontractible fiber region is longitudinally spaced from each othercircumferentially contractible fiber region. In certain embodiments, aplurality of radially contractible fiber regions (not shown butdescribed hereinafter in connection with FIGS. 28A-30) is arranged in oron the tubular body structure 251, wherein each radially contractiblefiber region is longitudinally spaced from each other radiallycontractible fiber region. In certain embodiments, the tubular bodystructure 251 comprises a polymer adhesive, and the guidewire device 250includes at least one electrical conductor (not shown) configured to becoupled with an electric power source for resistive heating of thepolymer adhesive to adjust a stiffness property of the polymer adhesive.

FIG. 28A illustrates a grid 264 of (horizontally arranged)longitudinally contractible fiber regions 262 and (vertically arranged)circumferentially contractible fiber regions 263 that may beincorporated into a guidewire device. Each contractible fiber region262, 263 may include a piezoelectric material, an electroactive polymer,and/or a nitinol alloy, and is preferably actuated with an electricalsignal. FIG. 28B is a perspective view illustration of a tubularstructure 265 of longitudinally contractible fiber regions 262 andcircumferentially contractible fiber regions 263 obtained by rolling thegrid 264 of FIG. 28A into a tubular shape. The tubular structure 265 ofFIG. 28B may be incorporated into a tubular body (e.g., via molding,dipping, coating, or another suitable method), such as a tubular body261 of a guidewire device 260 shown in the cross-sectional illustrationof FIG. 28C. The guidewire device 260 includes longitudinallycontractible fiber regions 262 and circumferentially contractible fiberregions 263 within the tubular body 261. In certain embodiments, thetubular body 261 may include polymer adhesive material. Although notshown in FIG. 28C, electrical conductors may extend in a generallylongitudinal direction within the tubular body 261 to conduct electricalsignals to various contractible fiber regions 262, 263. Eachcircumferentially contractible fiber region 263 of the plurality ofcircumferentially contractible fiber regions 263 is longitudinallyspaced from each other circumferentially contractible fiber region 263.Actuation of different circumferentially contractible fiber regions 263permits selective constriction of portions of the guidewire device 260,thereby adjusting local stiffness. Actuation of different longitudinallycontractible fiber regions 262 permits an angle or curvature of theguidewire device 260 to be altered. In combination, control of thecircumferentially contractible fiber regions 263 and the longitudinallycontractible fiber regions 262 may permit both stiffness and angle orcurvature of the guidewire device 260 to be adjusted at multiplelocations along its length.

FIG. 29 is a cross-sectional illustration of at least a portion of aguidewire device 270 similar to the guidewire device 260 of FIG. 28C,but with addition of a longitudinally extending flexible core 277, suchas may include one or more wires, fibers, or similar elements. Theguidewire device 270 further includes longitudinally contractible fiberregions 272 and circumferentially contractible fiber regions 273 withina tubular body 271. In certain embodiments, the core 277 comprises anelectrically conductive material (e.g., including one or moremetal-containing wires) to enable resistive heating of the tubular body271 to permit softening of the tubular body 271 to affect its stiffnessproperties.

FIG. 30 is a cross-sectional illustration of at least a portion of aguidewire device 280 similar to the guidewire device 260 of FIG. 28C,but with addition of a plurality of radially contractible fiber regions286 (e.g., a piezoelectric material, an electroactive polymer, or anitinol alloy) arranged in or on a tubular body 281. The radiallycontractible fiber regions 286 resemble spokes of a bicycle wheel.Actuation of different radially contractible fiber regions 286 permitsselective constriction of portions of the guidewire device 280,permitting stiffness of the guidewire device 280 to be locally adjusted.Multiple different radially contractible fiber regions 286 may belongitudinally spaced apart from one another and may be independentlycontrolled. The guidewire device 280 further includes longitudinallycontractible fiber regions 282 and circumferentially contractible fiberregions 283 within the tubular body 281. In certain embodiments, thetubular body 281 includes a polymer adhesive, and the guidewire device280 includes at least one electrical conductor (not shown) configured tobe coupled with an electric power source (not shown) for resistiveheating of the polymer adhesive to adjust a stiffness property of thepolymer adhesive.

FIG. 31 is a cross-sectional schematic illustration of a portion of aguidewire device 290 including a longitudinal axis 299, a first end290-1, a second end 290-2, and a tubular body 291 having an interior,with a centrally arranged flexible guide wire or track 293 (optionallyincluding teeth or grooves) arranged within the interior. Multiple(e.g., four) translatable elements 292A-292D are arranged toindependently translate along the flexible guide wire or track 293parallel to the longitudinal axis 299. Each translatable element292A-292D is electrically operable to be translated in a longitudinaldirection and thereby adjust a stiffness, angle, or curvature of theguidewire device 290 between the first end 290-1 and the second end290-2. In certain embodiments, each translatable element 292A-292Dincludes an electric motor unit. In certain embodiments, the electricmotor unit of each translatable element 292A-292D is controllable by asignal of a different frequency from each other electric motor unit ofthe guidewire device 290. In this manner, a single pair of conductors295 coupled to the motor of each translatable element 292A-292D may beused to separately control each motor. In certain embodiments, theflexible guide wire or track 293 includes a plurality of grooves orteeth, and each electric motor unit of the respective translatableelements 292A-292D includes an engagement element arranged to engagewith the plurality of grooves or teeth. In certain embodiments, thetubular body 291 includes a polymer adhesive, and the guidewire device290 includes at least one electrical conductor (not shown) configured tobe coupled with an electric power source (not shown) for resistiveheating of the polymer adhesive to adjust a stiffness property of thepolymer adhesive.

Upon reading the following description in light of the accompanyingdrawing figures, those skilled in the art will understand the conceptsof the disclosure and will recognize applications of these concepts notparticularly addressed herein. Those skilled in the art will recognizeimprovements and modifications to the preferred embodiments of thepresent disclosure. All such improvements and modifications areconsidered within the scope of the concepts disclosed herein and theclaims that follow.

What is claimed is:
 1. A guidewire device comprising: a tube having alongitudinal axis, a first end, a second end, and an interior; aplurality of body elements and a plurality of pivot joints sequentiallyarranged in a longitudinal direction within the interior of the tubebetween the first end and the second end, wherein each body element ofthe plurality of body elements is connected to at least one other bodyelement via at least one pivot joint of the plurality of pivot joints;and a plurality of tensile elements extending in the longitudinaldirection through the tube from the first end toward the plurality ofbody elements, wherein different tensile elements of the plurality oftensile elements terminate at different body elements of the pluralityof body elements, are separately operable to cause pivotal movementbetween different body elements of the plurality of body elements,thereby permitting adjustment of an angle or curvature of the guidewiredevice at multiple positions along the longitudinal axis.
 2. Theguidewire device of claim 1, wherein the plurality of tensile elementscomprises at least one agonist tensile element and at least oneantagonist tensile element, wherein the at least one antagonist tensileelement is configured to be operated to counteract the at least oneagonist tensile element to control pivotal movement between differentbody elements of the plurality of body elements.
 3. The guidewire deviceof claim 1, wherein the plurality of tensile elements is operativelyconnected to a plurality of tensioning elements configured toselectively apply tension to different tensile elements of the pluralityof tensile elements.
 4. The guidewire device of claim 3, wherein theplurality of tensioning elements is arranged beyond an end of the tube.5. The guidewire device of claim 1, further comprising a plurality ofcircumferentially contractible fiber regions arranged in or on the tube,wherein each circumferentially contractible fiber region of theplurality of circumferentially contractible fiber regions islongitudinally spaced from each other circumferentially contractiblefiber region.
 6. The guidewire device of claim 5, wherein eachcircumferentially contractible fiber region of the plurality ofcircumferentially contractible fiber regions comprises an electricallyresponsive material selected from the group consisting of apiezoelectric material, an electroactive polymer, and a nitinol alloy.7. The guidewire device of claim 1, further comprising a plurality ofradially contractible fiber regions arranged in or on the tube, whereineach radially contractible fiber region of the plurality of radiallycontractible fiber regions is longitudinally spaced from each otherradially contractible fiber region.
 8. The guidewire device of claim 7,wherein each radially contractible fiber region of the plurality ofradially contractible fiber regions comprises an electrically responsivematerial selected from the group consisting of a piezoelectric material,an electroactive polymer, and a nitinol alloy.
 9. The guidewire deviceof claim 1, wherein the tube comprises a polymer adhesive, and theguidewire device includes at least one electrical conductor configuredto be coupled with an electric power source for resistive heating of thepolymer adhesive to adjust a stiffness property of the polymer adhesive.10. The guidewire device of claim 1, comprising a metal coil spring orflexible metal sheath extending generally parallel to the longitudinalaxis and surrounding at least a portion of the tube.